• 의학교육논단
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• 제11권1호
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• pp.11-20
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• 2009

The purpose of this study was to introduce the concepts of experiential learning and the Kolb's model, and to review some applications of experiential learning theory in graduate medical education. The published literature on GME and education for general practitioners applying the experiential theory and the Kolb's model was reviewed. Experience learning defined the cyclical learning process which emphasizes the learners' reflective thinking of the learners' concrete experiences and their active participation in continuous learning actives. Kolb includes this 'cycle of learning' as a central principle in his experiential learning theory. This is typically expressed as a four-stage cycle of learning. Kolb's cycle moves through concrete experience(CE), reflective observation(RO), abstract conceptualization(AC) and active experimentation(AE). Components of continuing education of the adult learner were based on autonomy, context of learning, and competence and performance as educational objectives. Some strategies for graduate medical education were reflective thinking, self-directed learning, morning reporting and feedback with peer review, etc. Opportunities for learning from experience in practical life can be made to enhance reflective thinking and performance of practitioners. Strategies to develop reflective practice among physicians should be explored by further research.

• 의학교육논단
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• 제14권1호
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• pp.19-24
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• 2012

The purpose of this study was to observe how Ajou University School of Medicine runs its curriculum to cultivate professionalism. The paper also proposes a plan for the next step for the school. The Patient-Doctor-Society (PDS) course, begun in 2009, can be summarized by three characteristics. First, the PDS course is an integrated curriculum that is not a one-time program for a specific grade, but a continuous program open for all medical students. Second, the PDS course is designed following the philosophy and educational goals of the institution, and the curriculum assures maximum autonomy. Third, the PDS course is 'whole person education' that provides knowledge and teaches skills and an attitude. By analyzing the pros and cons of the program through annual evaluation, leaders of the program at Ajou will continue to consider what to teach and how to do so.

• 간호행정학회지
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• 제6권1호
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• pp.5-18
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• 2000

This study was conducted to analyze the degree of department satisfaction and correlation accordng to nurses's clinical characteristics. Data fors tudy were selected August, 1999. The sample coisted of 512 nurses working in K university hosptal in Seoul. The collected materials have been alyzed by percentage, average, t-test, ANOVA, arson Correlation Coefficiency using SPSS window 8.0 program. The result were as the follows ; 1. Fifty-one percent answered to be satisfactory in current department of work, and nurses who had been experienced the transfer are fifty percent, and nurse specialist is eight point two percent. 2. The order of the degree of department duty satisfaction was mutual action, professinal position, autonomy, assignment desire, relation between the doctor and nurses, wage, administration. 3. The result of the degree of department duty satisfaction according to the age has shown significant differences in administration and assignment desire, and the result of the degree of department duty satisfaction according to the education and religion has shown significant differences in administration, and the result of the degree of department duty satisfaction according to marital status has shown significant differences in wage and administration. 4. The result of the degree of department duty satisfaction according La the position has shown significant differences in administration, assignment desire and the sum of duty satisfaction, and the result of the degree of department duty satisfaction according to the nurse specialist has shown no significant differences in total areas, and the result of the degree of department duty satisfaction according to the transfer has shown significant differences in relation between the doctor and nurses, administration, autonomy and the sum of duty satisfaction. 5. The result of the degree of department duty satisfaction according to the nursing career and present assignment career has shown no significant differences in total areas, and the result of degree of department duty satisfaction according to the present assignment has shown significant differences in relation between doctor and nurses, administration, assignment desire and the sum of duty satisfaction. 6. The result of the degree of department duty satisfaction according to the request and experiences of trasfer has shown significant differences in wage, administration, assignment desire and the sum of duty satisfaction 7. The result of the degree of department duty satisfaction according to the degree of satisfaction of present assignment has shown no significant difference in professional position 8. The result of relation of nurses'a clinical characteristics and the degree of department duty satisfaction and the sum of duty satisfaction has shown no significant differences in age, present assignment career, but the result of nursing career has shown significant differences in relation between doctor and nurse, administration, autonomy, assignment desire and the sum of duty satisfaction. and the satisfaction of present assignment which was very effective on duty satisfaction was as significant correlation with wage, professinal position, relation between doctor and nurses, administration, autonomy assignment desire, mutual action and the sum of duty satisfaction. The above result show us that the degree of wage is effected on marital status, experience of transfer, degree of satisfaction of present assignment, request of transfef and the relation between doctor and nurses is effected on experience of transfer, present assignment, degree of satisfaction of present assignment and the administration is effected on age, education, marital status position, experiences of transfer, request of transfer, degree of satisfaction of present assignment and the autonomy is effected on experience of transfer, degree of satisfaction of present assignment and the assignment desire is effected on position, pre sent assignment, degree of satisfaction of present assignment, request of transfer and the mutual action is effected on present assignment. and the sum of duty satisfaction is effected on marital status, position, experience of transfer, request of transfer, present assignment, degree of satisfaction of present assignment.

• 동의생리병리학회지
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• 제22권5호
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• pp.1132-1139
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• 2008

The structure of medical profession is composed of multiple relations among state, patients, and medical professions. There are conflicts between the nation and medical professions because the nation controls the monopoly of medical professions through medical policies. Patients make relations with medical profession as medical consumers. And medical professions compete each other in order to gain the control of the medical market. This paper attempts to review the dynamic relations between the nation and medical professions. The medical professions and the nation are in conflict about the control of the autonomy of medical professions. The medical professions want to exercise the monopoly rights in their own area and, on the other had, the nation wants to prevent problems that might result from the monopoly by regulations and to have the control over the national operation. Given this, the common view of medical sociology is that the nation and the medical professions are in constant conflict. The arguments that the present medical sociology has on the relationship between the nation and medical professions can be summarized like these: first, the nation is the authenticator of medical system; second, the nation is a medical provider and consumer; and, third, the nation is a mediator of regulations and conflicts. Based on the above mentioned relations between the nation and medical professions, this paper attempts to see how the nation, which is one component of the medical structure, make influences on Korean Oriental doctors and Traditional Chinese doctors. So as to do this, the changes in medical policies and promoting policies for Korean Oriental medicine and Traditional Chinese medicine are analyzed. Finally, the differences in national policies of Korean Oriental medicine and Traditional Chinese medicine are compared.

• 대한간호학회지
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• 제31권2호
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• pp.279-291
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• 2001

Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.

• 한국응급구조학회지
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• 제16권1호
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• pp.65-80
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• 2012

Purpose: The objective of this study was to assess the job satisfaction and turnover intention of the emergency medical technicians (EMT) in the private ambulance service, to examine their job satisfaction and turnover intention, and to provide the solution for the management of the private ambulance service. Methods: The survey was conducted with 121 EMTs (73 paramedics, 36 basic EMTs and 12 nurses) in the private ambulance service in Korea from September 15 to October 14, 2011. In the reliability of the questionnaire, Cronbach's ${\alpha}$ was 0.790 for job satisfaction and 0.796 for turnover intention. Using SPSS 18.0, we obtained Cronbach's ${\alpha}$, frequencies, percentages, means, and standard deviations, and performed independent t-tests, ANOVA, and Pearson's correlation analysis. Results: 1) The mean score with regard to job satisfaction was 2.94 and that of their turnover intention was 4.23. In the area of job satisfaction, the mean score of the job demand area was 4.23; 3.97 for the job itself; 3.07 for the area of interaction; 2.98 for the area of autonomy: 2.67 for the organizational demand area; 2.67 for working conditions area; and 1.73 for the wage area. 2) Statistically significant difference was observed in job satisfaction according to age (F=3.819, p=.006), wages (t=-4.640, p=.000), terms of incumbency (F=3.868, p=.011), and in turnover intention it was according to sex (t=-1.995 p=.048), age (F=9.611, p=.000), education levels (F=6.974, p=.002), marital status (t=4.393, p=.000), wages (t=5.515, p=.000), license types (F=8.481, p=.001), and terms of incumbency ( F=14.115, p=.000). 3) The job satisfaction and the turnover intention had a negative correlation to each other (r=-.56, p<.000) in general, and in the sub-7 areas of job satisfaction, the correlation with turnover intention was high in order of the wage area (r=-.61, p=.000), working conditions area (r=-.52, p=.000), the area of autonomy (r=-.49, p=.000), the area of interaction (r=-.45, p=.000), the organizational demand area (r=-.40, p=.000), the job itself (r=-.24, p=.007) and the job demand area (r=-.24, p=.009). Conclusion: The government must take the charge of lowering the turnover intention among paramedics in the private ambulance service by providing the advantage in wages and fringe benefits. Ultimately, this would bring an improvement in the quality of medical emergency services to hospitals especially in the area of patient transfer and transportation.

• 의료법학
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• 제9권1호
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• pp.413-459
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• 2008

The Law has intervened to define rare circumstances in which a person should choose continuing life in United States. On the one hand, the law has traditionally acted to preservelife and to respect the sanctity of life. On the other hand, one's control over one's own body, and the right to determine what kind of medical care one will receive, is equally well respected and historically grounded. The competent patients have the right to forgo life-sustaining treatment, courts in United States have left many unanswered questions about the nature of that right. The right to choose to forgo life-sustaining treatment is a manifestation of a patient's autonomy interest. In United States, The Karen Quilan case gave rise to legislative activity in the host of state capitals, and several states had adopted statutes that formally recognized some forms of written directives describing some circumstances in which certain kinds of medical care could be terminated. These statues were sometimes dominated 'living will' acts, sometimes 'right to die' acts and ocasionally 'natural death' acts. Today virtually every state has produced a living will statue. In Korea, courts do not permit a terminally ill person to withhold or withdraw life-sustaining treatment. Living wills apply in case of terminal illness owing to a defect in legislation. Now In Korea, these lively dispute of legal policy on the preconditions and concrete procedure of living will act and natural death act. Through the legislation of living will act and natural death act, we should prepare some circumstances to respect patient's autonomy on the right to die. We should frame the cultural standard to make a decision of forgoing life-sustainin1g treatment under the discreet procedure.

• 보건행정학회지
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• 제22권3호
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• pp.365-382
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• 2012

Background : Public hospitals suffer worsening shortage of physicians and face great pressure of recruiting doctors. This study is aim to identify the factors associated with retention of physicians who are working in public hospitals. Methods : We conducted a cross-sectional and self-administered questionnaire survey in July, 2011. A total of 333 physicians responded from the 31 public hospitals. We analyzed the difference of job retention across the variables among doctors stratified as salaried and public health doctors. We used chi-square test and multiple logistic regression analysis. Results : To the salaried doctor, longer work period(OR=2.04 in 3rd quartile), professional autonomy(OR=2.69), and positive attitude toward public health(OR=2.39) affect to the higher job retention whereas complain of low income(OR=0.33) and complain of poor clinical environment(OR=0.26) affects to the lower job retention. To the public health doctors, community connections such as hometown(OR=6.27), spouse factors(OR=3.49), and positive attitude toward public health(OR=3.19) affect to the higher job retention. But longer work period(OR=0.17 in 3rd quartile) affects to the lower job retention. Conclusions : Associated factors of job retention vary across physician's status. Professional autonomy has major impact on the job retention to the salaried doctor. And familial factors as well as community relationship have greatest impact to the public health doctor. Positive attitude toward public health is associated with the higher job retention to the both of salaried and public health doctors.

• 가정∙방문간호학회지
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• 제7권1호
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• pp.73-82
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• 2000

Twenty-first century coming of health care in our country is in a situation of much conflict because the relationship between nurses and doctors is seen in terms of a traditional and vertical structure. Accordingly. it is very difficult to find collaboration amongst individuals of these two professions. Now nursing is trying to find independence and autonomy by carrying out independent professional skills. This study on collaboration and the obstacles hindering its pursuit. The strategies of collaboration to give better health care quality are as follows; First, a program for professionals should be developed to enhance professional knowledge and technology and train nursing professionals so that nursing can be acknowledged as a profession with a power to carry out on independent job. Second, collaboration reduces expenses and results in satisfactory performances of duty, high productivity, low incidence of medical accident, and higher satisfaction of the patient. Therefore the leader in the higher position should take positive stance for collaboration and help create a cooperative situation through the development of practical orders for collaboration. opening cooperative wards, and meeting for collaboration. Third, a collaboration model should be introduced into the courses of the nursing and medical school curriculum, which would influence job atmosphere after graduation. Fourth, nurses should have pride in their jobs as professionals and have confidence in their professional skill, knowledge and ability. Nurses should make an effort to share responsibility and have independence and autonomy. Fifth, common people as well as doctors know little about professional practice and the role of nurses, so a publicity campaign is also required.

• Journal of Oral Medicine and Pain
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• 제31권4호
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• pp.283-296
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• 2006

과학기술의 발전과 더불어 보건의료분야는 괄목할 성장을 가져왔고 국민생활 수준의 향상과 건강에 대한 관심이 고조됨에 따라 의료서비스의 수요가 급증하고 있다. 이 과정에서 국민의 권리의식의 신장, 의료행위의 본질에 대한 이해부족, 의료기술에 대한 지나친 기대, 상업화된 의료공급체계, 의사의 윤리의식 저하 및 의료법리에 대한 무지 그리고 사회적 불신풍조의 만연, 분쟁해결을 위한 제도적 장치의 결여 등이 요인으로 작용하여 의료사고 및 분쟁이 급증하는 추세이다. 본 연구는 치과관련 단체에서 보유하고 있는 소송과 관련된 자료 및 연세대학교 치과대학병원 구강내과에서 신체감정을 시행한 재판기록을 중심으로 하여 판결전문을 확보할 수 있는 치과 의료사고 판례 중 1994년부터 2004년까지의 민사소송 30례의 판례를 분석하여 다음과 같은 결과를 얻었다. 1. 소송의 연도별 분포에서 2000년 이후 급증하는 추세를 보였다. 2. 소송의 유형별 분포에서 발치와 관련된 소송이 전체의 36.7% 이었다. 3. 소송의 원인을 분석한 결과 불편감, 치료불만족과 관련된 것이 전체의 36.7%, 사망 및 영구손상이 각각 16.7% 이었다. 4. 원고의 소송결과 승소 및 강제조정, 화해권고결정이 60.0% 이었다. 5. 소송에 관련된 병원유형은 치과의원이 60.0%로 가장 높게 나타났다. 6. 소송의 심급별 구성비율에서 2,3심 이상 진행된 경우가 전체의 30.0% 이었다. 7. 손해배상 청구금액은 5천만원 이상 1억원 미만이 36.7%, 1억원 이상이 13.3% 이었고 손해배상 판결금액은 1천만원 이상 3천만원 미만이 40.0%, 1억원 이상이 6.7% 이었다. 8. 소송과 관련된 치과의사수는 2명 이상이 26.7%이었다. 9. 판결까지의 소요기간은 11개월에서 20개월이 46.7%, 21개월에서 30개월이 36.7% 이었다. 10. 의료과실 유무에서는 과실을 판정한 경우가 46.7% 이었고 소송과정에서 신체감정이나 사실조회가 이루어진 경우는 70.0% 이었다. 11. 의사패소 판례(18건)에서 판결의 주안점은 주의의무위반이 72.2% 이었고, 설명의무위반이 16.7% 이었다. 치과 의료분쟁의 경우 치료의 긴급성이 상대적으로 적어 의사의 설명의무 중요성이 폭넓게 요구되며, 주관적인 치료 만족도가 중요시되는 분야이기 때문에 결국 분쟁을 줄이는 방법으로 기술적인 과실도 줄여야 하지만 치과의사와 환자와의 신뢰 관계를 개선하는 것과 의사집단의 자율성(autonomy)의 회복이 중요하다. 그리고 불합리하게 시행되고 있는 의료배상책임보험의 보완과 함께 치과의사단체와 학계가 주도하는 교육 및 의료분쟁시 자문을 구할 수 있는 체계의 확립으로 의료분쟁에 대한 대처가 이루어져야 할 것이다.